Online screening and referral for postpartum depression: an exploratory study.

The fear and stigma associated with postpartum depression (PPD) is a major challenge in the treatment of this disease. Our goal is to develop innovative methods of screening women for the symptoms of PPD to facilitate referral and treatment. This study explores the efficacy of the Internet in reaching out to postpartum women in the convenience and privacy of their own homes, particularly those in rural and underserved areas. An exploratory study design was used to explore the feasibility and acceptability of online screening for PPD with postpartum women in the first 2-3 months after delivery (N = 18). In the first phase, a focus group was conducted with a small group of postpartum women; the second phase consisted of individual interviews of postpartum women in their homes; and in phase three, 10 women participated in the on-line screening intervention. PPD was measured using an online version of the Edinburgh Postnatal Depression Scale (EPDS) a well-established instrument with reported alpha reliabilities (0.81-0.88) across studies and concurrent validity demonstrated using the gold standard, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for depression interview. Qualitative data collected from all the participants were also analyzed. The sample included women age 18-29; 70 % White/Caucasian, 50 % low income, and the majority living in rural areas. The EPDS scores ranged from 0 to 13 (mean 8.0; SD 4.76). Participants described the online PPD screening process as easy, straightforward and personalized and provided additional suggestions for improvement.

Higher Cerebrospinal Fluid Levels of Amyloid-ß40 Following Traumatic Brain Injury Relate to Confrontation Naming Performance.

Background: Traumatic brain injury (TBI) may confer risk for Alzheimer's disease (AD) through amyloid-ß (Aß) overproduction. However, the relationship between TBI and Aß levels in cerebrospinal fluid (CSF) remains unclear. Objective: To explore whether Aß overproduction is implicated in the relationship between TBI and AD, we compared CSF levels of Aß in individuals with a TBI history versus controls (CTRLs) and related CSF Aß levels to cognitive markers associated with preclinical AD. Methods: Participants were 112 non-impaired Veterans (TBI = 56, CTRL = 56) from the Alzheimer's Disease Neuroimaging Initiative-Department of Defense database with available cognitive data (Boston Naming Test [BNT], Rey Auditory Verbal Learning Test [AVLT]) and CSF measures of Aß42, Aß40, and Aß38. Mediation models explored relationships between TBI history and BNT scores with Aß peptides as mediators. Results: The TBI group had higher CSF Aß40 (t = -2.43, p = 0.017) and Aß38 (t = -2.10, p = 0.038) levels than the CTRL group, but groups did not differ in CSF Aß42 levels or Aß42/Aß40 ratios (p > 0.05). Both Aß peptides negatively correlated with BNT (Aß40: rho = -0.20, p = 0.032; Aß38: rho = -0.19, p = 0.048) but not AVLT (p > 0.05). Aß40 had a significant indirect effect on the relationship between TBI and BNT performance (ß= -0.16, 95% CI [-0.393, -0.004], PM = 0.54). Conclusions: TBI may increase AD risk and cognitive vulnerability through Aß overproduction. Biomarker models incorporating multiple Aß peptides may help identify AD risk among those with TBI.

Traumatic Brain Injury and Genetic Risk for Alzheimer's Disease Impact Cerebrospinal Fluid ß-Amyloid Levels in Vietnam War Veterans.

Traumatic brain injuries (TBIs) may increase the risk for Alzheimer's disease (AD) and its neuropathological correlates, although the mechanisms of this relationship are unclear. The current study examined the synergistic effects of TBI and genetic risk for AD on ß-amyloid (Aß) levels among Vietnam War Veterans. We hypothesized that the combination of TBI and higher polygenic risk score (PRS) for AD would be associated with lower cerebrospinal fluid (CSF) Aß42/40. Data were obtained from the Department of Defense Alzheimer's Disease Neuroimaging Initiative. Participants included Vietnam War Veterans without dementia who identified as White non-Hispanic/Latino and had available demographic, clinical assessment, genetic, and CSF biomarker data. Lifetime TBI history was assessed using The Ohio State University TBI Identification Method. Participants were categorized into those with and without TBI. Among those with a prior TBI, injury severity was defined as either mild or moderate/severe. CSF Aß42/40 ratios were calculated. Genetic propensity for AD was assessed using PRSs. Hierarchical linear regression models examined the interactive effects of TBI and PRS for AD on Aß42/40. Exploratory analyses examined the interaction between TBI severity and PRS. The final sample included 88 male Vietnam War Veterans who identified as White non-Hispanic/Latino (M age = 68.3 years), 49 of whom reported a prior TBI. There was a significant interaction between TBI and PRS, such that individuals with TBI and higher PRS for AD had lower Aß42/40 (B = -0.45, 95% CI: -0.86 to -0.05, p = 0.03). This relationship may be stronger with increasing TBI severity (p = 0.05). Overall, TBI was associated with lower Aß42/40, indicating greater amyloid deposition in the brain, in the context of greater polygenic risk for AD. These findings highlight who may be at increased risk for AD neuropathology following TBI.

Effect of race and socioeconomic status on cardiovascular risk factor burden: the Cooper Center Longitudinal Study.

OBJECTIVES: This study examines the prevalence of cardiovascular risk factors and chronic disease burden among African Americans compared to Caucasians in a population of higher socioeconomic status. DESIGN: The current study is a cross-sectional, secondary data analysis of the Cooper Center Longitudinal Study. SETTING: Patients with a medical examination from 1970-2010 at the Cooper Clinic. PARTICIPANTS: 762 African Americans and 40,051 Caucasians who met the criteria. OUTCOME MEASURES: Racial differences in cardiovascular risk factors/burden of disease between African Americans and Caucasians. RESULTS: African Americans had higher prevalence of evaluated cardiovascular risk factors than did Caucasians after controlling for obesity, tobacco use, and physical fitness. Caucasians had greater likelihood of no risk factors while African Americans were more likely to have all three risk factors. Race was typically predictive of cardiovascular risk factors in African Americans compared to Caucasians. CONCLUSIONS: Findings suggest that health differences persist despite greater socioeconomic status, and further investigations of biopsychosocial causes are warranted.

Frontal Atrophy and Executive Dysfunction Relate to Complex Numbers Impairment in Progressive Supranuclear Palsy.

BACKGROUND: Previous research finds a range of numbers impairments in Parkinsonian syndromes (PS), but has largely focused on how visuospatial impairments impact deficits in basic numerical processes (e.g., magnitude judgments, chunking). Differentiation between these basic functions and more complex numerical processes often utilized in everyday tasks may help elucidate neurocognitive and neuroanatomic bases of numbers deficits in PS. OBJECTIVE: To test neurocognitive and neuroanatomic correlates of complex numerical processing in PS, we assessed number abilities, neuropsychological performance, and cortical thickness in progressive supranuclear palsy (PSP) and Lewy body spectrum disorders (LBSD). METHODS: Fifty-six patients (LBSD = 35; PSP = 21) completed a Numbers Battery, including basic and complex numerical tasks. The Mini-Mental State Exam (MMSE), letter fluency (LF), and Judgment of Line Orientation (JOLO) assessed global, executive, and visuospatial functioning respectively. Mann-Whitney U tests compared neuropsychological testing and rank-transformed analysis of covariance (ANCOVA) compared numbers performance between groups while adjusting for demographic variables. Spearman's and partial correlations related numbers performance to neuropsychological tasks. Neuroimaging assessed cortical thickness in disease groups and demographically-matched healthy controls. RESULTS: PSP had worse complex numbers performance than LBSD (F = 6.06, p = 0.02) but similar basic numbers performance (F = 0.38, p > 0.1), covarying for MMSE and sex. Across syndromes, impaired complex numbers performance was linked to poor LF (rho = 0.34, p = 0.01) but not JOLO (rho = 0.23, p > 0.05). Imaging revealed significant frontal atrophy in PSP compared to controls, which was associated with worse LF and complex numbers performance. CONCLUSION: PSP demonstrated selective impairments in complex numbers processing compared to LBSD. This complex numerical deficit may relate to executive dysfunction and frontal atrophy.

Natural speech markers of Alzheimer's disease co-pathology in Lewy body dementias.

INTRODUCTION: An estimated 50% of patients with Lewy body dementias (LBD), including Parkinson's disease dementia (PDD) and Dementia with Lewy bodies (DLB), have co-occurring Alzheimer's disease (AD) that is associated with worse prognosis. This study tests an automated analysis of natural speech as an inexpensive, non-invasive screening tool for AD co-pathology in biologically-confirmed cohorts of LBD patients with AD co-pathology (SYN + AD) and without (SYN-AD). METHODS: We analyzed lexical-semantic and acoustic features of picture descriptions using automated methods in 22 SYN + AD and 38 SYN-AD patients stratified using AD CSF biomarkers or autopsy diagnosis. Speech markers of AD co-pathology were identified using best subset regression, and their diagnostic discrimination was tested using receiver operating characteristic. ANCOVAs compared measures between groups covarying for demographic differences and cognitive disease severity. We tested relations with CSF tau levels, and compared speech measures between PDD and DLB clinical disorders in the same cohort. RESULTS: Age of acquisition of nouns (p = 0.034, |d| = 0.77) and lexical density (p = 0.0064, |d| = 0.72) were reduced in SYN + AD, and together showed excellent discrimination for SYN + AD vs. SYN-AD (95% sensitivity, 66% specificity; AUC = 0.82). Lower lexical density was related to higher CSF t-Tau levels (R = -0.41, p = 0.0021). Clinically-diagnosed PDD vs. DLB did not differ on any speech features. CONCLUSION: AD co-pathology may result in a deviant natural speech profile in LBD characterized by specific lexical-semantic impairments, not detectable by clinical disorder diagnosis. Our study demonstrates the potential of automated digital speech analytics as a screening tool for underlying AD co-pathology in LBD.

Vibrational Sum Frequency Generation Spectroscopy of Surface Hydroxyls on Nickel Phyllosilicate Nanoscrolls.

Phyllosilicate clays are layered structures with diverse nanoscale morphology depending on the composition. Size mismatch between the sheets can cause them to form nanoscrolls, a spiral structure with different inner and outer surface charges. The hydroxyls on the exposed surface of the nanoscrolls determine the adsorption properties and hydrophilicity of the surface. Vibrational sum frequency generation (VSFG) spectroscopy was applied to study the surface hydroxyls of nickel phyllosilicate (Ni3Si2O5(OH)4), revealing three distinct in-phase OH-stretch modes: 3642, 3645, and 3653 cm-1. The relative signs of the peaks allow their assignment as "outward" and "inward" pointing hydroxyls on the opposite sides of the scrolled sheet, consistent with the crystal structure. Orientational analysis of polarization-selected VSFG spectra is consistent with a broad (140-164°) step-function distribution of the OH-stretch tilt angles, which we attribute to the uncompensated portion of the scroll rolled more than a whole number of full turns.

Cognitive Profile and Markers of Alzheimer Disease-Type Pathology in Patients With Lewy Body Dementias.

OBJECTIVE: To determine whether patients with Lewy body dementia (LBD) with likely Alzheimer disease (AD)-type copathology are more impaired on confrontation naming than those without likely AD-type copathology. METHODS: We selected 57 patients with LBD (dementia with Lewy bodies [DLB], n = 38; Parkinson disease dementia [PDD], n = 19) with available AD CSF biomarkers and neuropsychological data. CSF ß-amyloid1-42 (Aß42), phosphorylated-tau (p-tau), and total-tau (t-tau) concentrations were measured. We used an autopsy-validated CSF cut point (t-tau:Aß42 ratio > 0.3, n = 43), or autopsy data when available (n = 14), to categorize patients as having LBD with (LBD + AD, n = 26) and without (LBD - AD, n = 31) likely AD-type copathology. Analysis of covariance tested between-group comparisons across biologically defined groups (LBD + AD, LBD - AD) and clinical phenotypes (DLB, PDD) on confrontation naming (30-item Boston Naming Test [BNT]), executive abilities (letter fluency [LF], reverse digit span [RDS]), and global cognition (Mini-Mental State Examination [MMSE]), with adjustment for age at dementia onset, time from dementia onset to test date, and time from CSF to test date. Spearman correlation related cognitive performance to CSF analytes. RESULTS: Patients with LBD + AD performed worse on BNT than patients with LBD - AD (F = 4.80, p = 0.03); both groups performed similarly on LF, RDS, and MMSE (all p > 0.1). Clinically defined PDD and DLB groups did not differ in performance on any of these measures (all p > 0.05). A correlation across all patients showed that BNT score was negatively associated with CSF t-tau (ρ = -0.28, p < 0.05) and p-tau (ρ = -0.26, p = 0.05) but not Aß42 (p > 0.1). CONCLUSION: Markers of AD-type copathology are implicated in impaired language performance in LBD. Biologically based classification of LBD may be advantageous over clinically defined syndromes to elucidate clinical heterogeneity.

More Than Words: Extra-Sylvian Neuroanatomic Networks Support Indirect Speech Act Comprehension and Discourse in Behavioral Variant Frontotemporal Dementia.

Indirect speech acts-responding "I forgot to wear my watch today" to someone who asked for the time-are ubiquitous in daily conversation, but are understudied in current neurobiological models of language. To comprehend an indirect speech act like this one, listeners must not only decode the lexical-semantic content of the utterance, but also make a pragmatic, bridging inference. This inference allows listeners to derive the speaker's true, intended meaning-in the above dialog, for example, that the speaker cannot provide the time. In the present work, we address this major gap by asking non-aphasic patients with behavioral variant frontotemporal dementia (bvFTD, n = 21) and brain-damaged controls with amnestic mild cognitive impairment (MCI, n = 17) to judge simple question-answer dialogs of the form: "Do you want some cake for dessert?" "I'm on a very strict diet right now," and relate the results to structural and diffusion MRI. Accuracy and reaction time results demonstrate that subjects with bvFTD, but not MCI, are selectively impaired in indirect relative to direct speech act comprehension, due in part to their social and executive limitations, and performance is related to caregivers' judgment of communication efficacy. MRI imaging associates the observed impairment in bvFTD to cortical thinning not only in traditional language-associated regions, but also in fronto-parietal regions implicated in social and executive cerebral networks. Finally, diffusion tensor imaging analyses implicate white matter tracts in both dorsal and ventral projection streams, including superior longitudinal fasciculus, frontal aslant, and uncinate fasciculus. These results have strong implications for updated neurobiological models of language, and emphasize a core, language-mediated social disorder in patients with bvFTD.

Hydrothermal Preparation, Crystal Chemistry, and Redox Properties of Iron Muscovite Clay.

The development of functional materials based on Earth-abundant, environmentally benign compositions is critical for ensuring their commercial viability and sustainable production. Here we present an investigation into the crystal chemistry and electrochemical properties of the muscovite clay KFe2.75Si3.25O10(OH)2. We first report a low-temperature hydrothermal reaction that allows for a significant degree of control over sample crystallinity, particle morphology, and cation distribution through the lattice. A complex sequence of stacking faults is identified and characterized using a combination of Mössbauer spectroscopy and total scattering neutron experiments. We then show the existence of a reversible electrochemical process using galvanostatic cycling with complementary cyclic voltammetry suggesting that the redox activity occurs primarily on the surface of the particles. We conclude by determining that the ability to (de)intercalate Li ions from the material is hindered by the strong negative charge on the transition metal silicate layers, which prevents the displacement of the interlayer K ions. This work calls attention to a hugely Earth-abundant family of minerals that possesses useful electrochemical properties that warrant further exploration.

Physical activity and musculoskeletal injuries in women: the Women's Injury Study.

BACKGROUND: Increased injury rates have been associated with physical activity (PA). The differences in musculoskeletal injury (MSI) characteristics resulting from PA, versus those unrelated to PA, are unknown. We describe the pattern of PA and non-PA MSI incurred by community-dwelling women. METHODS: Data were extracted from the Women's Injury Study, a web-based observational study that tracked weekly PA behaviors and self-reported MSI of 909 community-dwelling women ages 20-83 years. The primary outcome was self-reported MSI that interrupted daily activities ≥2 days and/or required treatment from a health care provider. Follow-up telephone reporting of MSIs allowed further description of injuries. Mixed effects logistic regression was used to identify injury sites associated with PA, controlling for age, body mass index, previous injury, and use of alcohol. RESULTS: Incidence of PA and non-PA MSIs were comparable; some differences in injury characteristics were evident across 83,241 person-weeks of reporting. Non-PA MSIs were more likely to come on "suddenly" (54% vs. 8%) and commonly involved head/jaw/neck injuries. Reported PA-related MSIs were less likely to require health care provider treatment (60% vs. 80%) and resulted in less missed days of work/school (11%) versus non-PA MSIs (17%). Compared to non-PA related injuries, PA-related injuries were more likely to involve the lower (odds ratio [OR]=3.10, p=0.002) or upper limbs (OR=2.54, p=0.01) and less likely to involve the head/jaw/neck (OR=0.21, p=0.002). CONCLUSION: There are some differences in mechanisms of injury, the distribution of injuries by anatomical location, and the treatment of injuries depending on aerobic activity participation, although absolute rates of MSI were comparable.

The impact of race and higher socioeconomic status on cardiorespiratory fitness.

PURPOSE: Previous studies suggest that African Americans (AA) have lower levels of cardiorespiratory fitness (CRF) than their Caucasian (C) counterparts. However, the association between CRF and race/ethnicity in the context of higher socioeconomic status (SES) has not been explored. METHODS: We evaluated 589 AA (309 men and 203 women) and 33,015 C (19,399 men and 8753 women) enrolled in the Cooper Center Longitudinal Study. Education years and access to a preventive health care examination were used as a proxy for higher SES. Data were collected from a questionnaire, maximal treadmill exercise stress test, and other clinical measures. The outcome variable was CRF, which was stratified into low fit (quintile 1 of CRF) and fit (quintiles 2-5). Multivariable regression was used to compare adjusted mean CRF between groups. P values were adjusted for unbalanced sample size and unequal variance between groups. RESULTS: The mean education years were similar for AA and C men at 16 yr; however, AA women had more years of education than C (15.8 vs 15.2 yr, P = 0.0062). AA men and women had a significantly higher prevalence of being unfit compared with their C counterparts (men 26.7% vs 12.6%, P < 0.0001; women 21.3% vs 8.4%, P < 0.0001). The adjusted mean estimated maximal METs were 10.9 vs 11.7 and 8.8 vs 9.8 for AA and C men and women, respectively. Fully adjusted odds ratios revealed that AA men had more than twice the risk of being unfit compared with C men. A trend persisted for AA women to have a lower MET value than their counterparts. CONCLUSIONS: Despite comparable higher SES, lower CRF existed among AA men versus C men. These results suggest that CRF may not be mediated strictly by environmental factors related to SES.

Global consequences of land use.

Land use has generally been considered a local environmental issue, but it is becoming a force of global importance. Worldwide changes to forests, farmlands, waterways, and air are being driven by the need to provide food, fiber, water, and shelter to more than six billion people. Global croplands, pastures, plantations, and urban areas have expanded in recent decades, accompanied by large increases in energy, water, and fertilizer consumption, along with considerable losses of biodiversity. Such changes in land use have enabled humans to appropriate an increasing share of the planet's resources, but they also potentially undermine the capacity of ecosystems to sustain food production, maintain freshwater and forest resources, regulate climate and air quality, and ameliorate infectious diseases. We face the challenge of managing trade-offs between immediate human needs and maintaining the capacity of the biosphere to provide goods and services in the long term.